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General NPI Number Information
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NPI Number | 1639963630
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Entity Type | Individual
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Provider Name | CASSIDY MAUK CRNP
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Gender | Female
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 145 HOSPITAL AVE STE 211
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City | DU BOIS
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State | PA
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Zip | 15801-1464
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Country | US
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Telephone | 814-375-3722
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Fax |
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Provider Business Mailing Address
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Address Line | 111 TREASURE LAKE 17161 TREASURE LAKE ROAD
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City | DUBOIS
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State | PA
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Zip | 15801
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Country | US
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Telephone | 814-591-5819
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP032602
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License Number State | PA
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